The uncertainty in illness theory proposes that Buncertainty
exists in illness situations that are ambiguous,
complex, unpredictable, and when information is unavailable
or inconsistent.[21 The description of the situation in
which uncertainty exists can be likened to the environment
of the ICU. There are multiple complexities, those
relating the complex disease process of the patient, and
the complexities of technology in the equipment used in
caring for the patient. Patients who are unstable can demonstrate
unpredictable responses to medications and treatment
courses. The information exchange between nurses
and family members can be inconsistent or at times even
unavailable if the nurse is unable to communicate with the
family. All of these factors pave the way for uncertainty to
exist in situations that family members of patients in the
ICU find themselves in.
Stimuli frame is the primary antecedent variable in
Mishel’s21 model of uncertainty in illness. Stimuli frame
has 3 components: symptom pattern, event familiarity, and
event congruency.21 Event familiarity refers to patterns
within the health care environment and is developed over
time and through experience in a setting. Family members
who find themselves in an environment that is characterized
by ever-changing rules and inconsistencies in information
exchange will have increased feelings of trepidation
and uncertainty. With event familiarity, uncertainty can be
prevented.21
Family members have expectations that include quality
care, competence, and information exchange. They also
develop patterns of visiting and participating in the care of
their loved ones. Event congruence refers to the consistency
between what is expected and what is experienced, and a
lack of congruence can generate uncertainty.21 If family
members have become accustomed to being able to visit
the patient whenever they choose, and a nurse evokes the
right to limit visiting hours, event congruence lacks. Another
example of this can occur when family members
assist the patient with personal care. Some nurses may be
appreciative or accepting of this and others may be more
comfortable if that work is left to the nursing staff. These
examples serve as demonstrations of inconsistencies between
what is expected and what is experienced and show
a lack of congruence. Lack of congruence in nursing can
generate the feeling of trepidation in family members who
are on guard for an ever-changing system of rules and
information exchange that may occur as frequently as
every shift change.
A graphic representation of the relationship between
feeling trepidation and Mishel’s uncertainty in illness
theory in displayed in the Figure.21 When the 3 components
of timidity, an unknown, and an emotional disturbance
or excitement come together, trepidation may be
present. Uncertainty surrounds the family member who is
experiencing a feeling of trepidation.